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Surf lifesaving members are essential first responders who patrol public waterways, performing rescues and resuscitation to individuals in the community when needed. In this way, surf lifesaving members experience arduous physical requirements alongside extensive psychological stress during resuscitation. Surf Life Saving Queensland (SLSQ) represents the predominant, frontline lifesaving service in Queensland, Australia; however, little research has explored key aspects of drowning resuscitations involving this organisation, as well as in the broader lifesaving industry, limiting current understanding on this vital topic. We sought to explore key aspects of drowning resuscitations within SLSQ and create a framework to generate evidence-based practice. In guiding future lines of inquiry addressing this deficiency, a six-step research framework has been proposed to aid in holistically understanding the resuscitation process from a surf lifesaving perspective. Evidence generated from applying this framework will create a much- needed knowledge base for surf lifesaving organisations to use in the development of practical, strategic, and effective decisions to enhance their practices and ultimately better prevent drowning fatalities. [ABSTRACT FROM AUTHOR]

BACKGROUND: During pulseless electrical activity (PEA) the cardiac mechanical and electrical functions are dissociated, a phenomenon occurring in 25-42% of in-hospital cardiac arrest (IHCA) cases. Accurate evaluation of the likelihood of a PEA patient transitioning to return of spontaneous circulation (ROSC) may be vital for the successful resuscitation. THE AIM: We sought to develop a model to automatically discriminate between PEA rhythms with favorable and unfavorable evolution to ROSC. METHODS: A dataset of 190 patients, 120 with ROSC, were acquired with defibrillators from different vendors in three hospitals. The ECG and the transthoracic impedance (TTI) signal were processed to compute 16 waveform features. Logistic regression models where designed integrating both automated features and characteristics annotated in the QRS to identify PEAs with better prognosis leading to ROSC. Cross validation techniques were applied, both patient-specific and stratified, to evaluate the performance of the algorithm. RESULTS: The best model consisted in a three feature algorithm that exhibited median (interquartile range) Area Under the Curve/Balanced accuracy/Sensitivity/Specificity of 80.3(9.9)/75.6(8.0)/ 77.4(15.2)/72.3(16.4) %, respectively. CONCLUSIONS: Information hidden in the waveforms of the ECG and TTI signals, along with QRS complex features, can predict the progression of PEA. Automated methods as the one proposed in this study, could contribute to assist in the targeted treatment of PEA in IHCA.

Blended learning (BL) has recently been extensively utilized as an effective instructional method in the educational field. Despite its benefits, few studies investigate its impact on cardiopulmonary resuscitation (CPR) training programs for non-medical students and staff. The importance of CPR training lies in its contribution to achieving the third sustainable development goal (SDG) by enhancing survival rates. Nevertheless, some obstacles have hindered university students from participating in these courses. This study aims to identify the impact of blended learning, which integrates asynchronous online learning with face-toface instruction, on CPR knowledge and attitudes among non-medical undergraduates. Using a true experimental design, the experimental group (n = 41) received the BL CPR training program while the control group (n = 40) received the convolutional CPR training program. Data were collected using a developed CPR knowledge test and an attitude measure toward performing CPR before and after the program. The analysis of covariance (ANCOVA) analysis at the 5% significance level (p < 0.05) revealed a significant positive influence of the BL method on enhancing students' CPR knowledge and their attitudes toward performing it. These results recommend that decision-makers employ BL programs to enhance students' CPR knowledge and attitudes toward performing it. [ABSTRACT FROM AUTHOR]

For many years, ventilation has been an essential part of advanced life support (ALS) in cardiopulmonary resuscitation (CPR). Nevertheless, there is little evidence about the best method of ventilation during resuscitation for both out-of-hospital cardiac arrest (OHCA) and inhospital cardiac arrest (IHCA) patients. Effective ventilation is one of the two main keys to successful resuscitation. In this context, the question always arises as to which airway management, along with which ventilation mode, constitutes the best strategy. Conventional ventilation modes are not designed for cardiac arrest and show important limitations that must be considered when used in CPR. Manual ventilation without the use of an automated transport ventilator (ATV) could be shown to be uncontrolled in applied volumes and pressures and should be avoided. Mechanical ventilation with an ATV is therefore superior to manual ventilation, but both volume- and pressure-controlled ventilation modes are significantly influenced by chest compressions. With the newly designed chest compression synchronized ventilation (CCSV), a special ventilation mode for resuscitation is available. Further research should be conducted to obtain more evidence of the effect of ventilation during CPR on outcomes following OHCA and not only about how to secure the airway for ventilation during CPR. [ABSTRACT FROM AUTHOR]

Background: Reducing the time to treatment by means of cardiopulmonary resuscitation (CPR) and defibrillation is essential to increasing survival after cardiac arrest. A novel method of dispatching drones for delivery of automated external defibrillators (AEDs) to the site of a suspected out-of-hospital cardiac arrest (OHCA) has been shown to be feasible, with the potential to shorten response times compared with the emergency medical services. However, little is known of dispatchers' experiences of using this novel methodology. Methods: A qualitative semi-structured interview study with a phenomenological approach was used. Ten registered nurses employed at an emergency medical dispatch centre in Gothenburg, Sweden, were interviewed and the data was analysed by qualitative content analysis. The purpose was to explore dispatcher nurses' experiences of deliveries of AEDs by drones in cases of suspected OHCA. Results: Three categories were formed. Nurses expressed varying compliance to the telephone-assisted protocol for dispatch of AED-equipped drones. They experienced uncertainty as to how long would be an acceptable interruption from the CPR protocol in order to retrieve a drone-delivered AED. The majority experienced that collegial support was important. Technical support, routines and training need to be improved to further optimise action in cases of drone-delivered AEDs handled by dispatcher nurses. Conclusions: Although telephone-assisted routines for drone dispatch in cases of OHCA were available, their use was rare. Registered nurses showed variable degrees of understanding of how to comply with these protocols. Collegial and technical support was considered important, alongside routines and training, which need to be improved to further support bystander use of drone-delivered AEDs. As the possibilities of using drones to deliver AEDs in cases of OHCA are explored more extensively globally, there is a good possibility that this study could be of benefit to other nations implementing similar methods. We present concrete aspects that are important to take into consideration when implementing this kind of methodology at dispatch centres. [ABSTRACT FROM AUTHOR]

Abstract Background Reducing the time to treatment by means of cardiopulmonary resuscitation (CPR) and defibrillation is essential to increasing survival after cardiac arrest. A novel method of dispatching drones for delivery of automated external defibrillators (AEDs) to the site of a suspected out-of-hospital cardiac arrest (OHCA) has been shown to be feasible, with the potential to shorten response times compared with the emergency medical services. However, little is known of dispatchers’ experiences of using this novel methodology. Methods A qualitative semi-structured interview study with a phenomenological approach was used. Ten registered nurses employed at an emergency medical dispatch centre in Gothenburg, Sweden, were interviewed and the data was analysed by qualitative content analysis. The purpose was to explore dispatcher nurses’ experiences of deliveries of AEDs by drones in cases of suspected OHCA. Results Three categories were formed. Nurses expressed varying compliance to the telephone-assisted protocol for dispatch of AED-equipped drones. They experienced uncertainty as to how long would be an acceptable interruption from the CPR protocol in order to retrieve a drone-delivered AED. The majority experienced that collegial support was important. Technical support, routines and training need to be improved to further optimise action in cases of drone-delivered AEDs handled by dispatcher nurses. Conclusions Although telephone-assisted routines for drone dispatch in cases of OHCA were available, their use was rare. Registered nurses showed variable degrees of understanding of how to comply with these protocols. Collegial and technical support was considered important, alongside routines and training, which need to be improved to further support bystander use of drone-delivered AEDs. As the possibilities of using drones to deliver AEDs in cases of OHCA are explored more extensively globally, there is a good possibility that this study could be of benefit to other nations implementing similar methods. We present concrete aspects that are important to take into consideration when implementing this kind of methodology at dispatch centres.

Abstract For many years, ventilation has been an essential part of advanced life support (ALS) in cardiopulmonary resuscitation (CPR). Nevertheless, there is little evidence about the best method of ventilation during resuscitation for both out-of-hospital cardiac arrest (OHCA) and inhospital cardiac arrest (IHCA) patients. Effective ventilation is one of the two main keys to successful resuscitation. In this context, the question always arises as to which airway management, along with which ventilation mode, constitutes the best strategy. Conventional ventilation modes are not designed for cardiac arrest and show important limitations that must be considered when used in CPR. Manual ventilation without the use of an automated transport ventilator (ATV) could be shown to be uncontrolled in applied volumes and pressures and should be avoided. Mechanical ventilation with an ATV is therefore superior to manual ventilation, but both volume- and pressure-controlled ventilation modes are significantly influenced by chest compressions. With the newly designed chest compression synchronized ventilation (CCSV), a special ventilation mode for resuscitation is available. Further research should be conducted to obtain more evidence of the effect of ventilation during CPR on outcomes following OHCA and not only about how to secure the airway for ventilation during CPR.

Introduction: Extracorporeal membrane oxygenation (ECMO) improves infant survival outcomes after cardiac arrest. If not feasible at the place of arrest, victims must be transported to a suitable room to perform ECMO while effective, sustained resuscitation maneuvers are performed. The objective of this simulation study was to compare the quality of resuscitation maneuvers on an infant manikin during simulated transfer on a stretcher (stretcher test) within a hospital versus standard stationary resuscitation maneuvers (control test). Methods: A total of 26 nursing students participated in a randomized crossover study. In pairs, the rescuers performed two 2 min tests, consisting of five rescue breaths followed by cycles of 15 compressions and two breaths. The analysis focused on CPR variables (chest compression and ventilation), CPR quality, the rate of perceived exertion and the distance covered. Results: No differences were observed in the chest compression quality variable (82 ± 10% versus 84 ± 11%, p = 0.15). However, significantly worse values were observed in the test for ventilation quality on the stretcher (18 ± 14%) compared to the control test (28 ± 21%), with a value of p = 0.030. Therefore, the overall CPR quality was worse in the stretcher test (50 ± 9%) than in the control test (56 ± 13%) (p = 0.025). Conclusions: Infant CPR performed by nursing students while walking alongside a moving stretcher is possible. However, in this model, the global CPR quality is less due to the low ventilation quality. [ABSTRACT FROM AUTHOR]

The Effect of an Educational Intervention Programme on Allied Health Students Knowledge, Attitude, and Practice Regarding Cardiopulmonary Resuscitation What does this paper add? Interventional studies in Jordan regarding Cardiopulmonary Resuscitation (CPR) knowledge, attitude and practice in allied heath students are limited. Therefore, to provide pertinent information on this crucial topic for a rising country, such as Jordan. Emphasize learning CPR must be incorporated with skills, including the cooperation and proper communication between all health team members. Because of that, it is worth considering teaching CPR skills in all groups of health members at level of students, whom are the future encounter professionals. Falastine Hamdan: PhD, MSN, RN. Al-Balqa Applied University, Irbid University College, Salt, Jordan. falsteen.hamdan@bau.edu.jo. Mohammad Etoom: MSN, RN. Al-Balqa Applied University, Irbid University College, Salt, Jordan. Email: Maetoom@bau.edu.jo. Rafi Alnjadat: PhD, MSN, RN. Al-Balqa Applied University, Irbid University College, Salt, Jordan. Email: rafi.alnjadat@bau.edu.jo. Eshraq Momani: MSN, RN. Al-Balqa Applied University, Irbid University College, Salt, Jordan. Email: esshraq.momani@bau.edu.jo. Salwa Abu-ALrub: MSN, RN. Al-Balqa Applied University, Irbid University College, Salt, Jordan. Email: salwa.abual@bau.edu.jo. Correspondence author: Falastine Hamdan. Email: Falsteen.hamdan@bau.edu.jo.

Objective: This study involving automated external defibrillators (AEDs) in early treatment of refibrillation aims to evaluate the performance of a new shock advisory system (SAS) during chest compressions (CC) in out-of-hospital cardiac arrest (OHCA) patients. Methods: This work focuses on AED SAS performance as a secondary outcome of DEFI 2022 clinical prospective study, which included first-analysis shockable OHCA patients. SAS employs the Analyze Whilst Compressing (AWC) algorithm to interact with both cardiopulmonary resuscitation (CPR) and shock advice by conditional operation of two-stage ECG analysis in presence or absence of chest compressions. AWC is triggered by the first-shock recommendation. Then, after 1 min of CPR, ECG analysis during CC decides between two treatment scenarios. For patients with refibrillation, CPR is paused for immediate confirmation analysis and shock advice. For patients with non-shockable rhythms, CPR is continued for 2 min until standard analysis. Results: Clinical data from 285 OHCA patients with shock recommendation at the first-analysis by AEDs (DEFIGARD TOUCH7, Schiller Médical) consisted of 576 standard analyses, 2011 analyses during CC, 577 confirmation analyses in absence of CC. Global AED SAS performance meets the standard recommendations for arrhythmia analysis sensitivity (94.9%) and specificity (>99.3%). AWC provided innovative treatment of shockable rhythms by stopping CPR earlier than 2 min in most ventricular fibrillations (92.9%), while most non-shockable patients (86.5–95.2%) benefitted from continuous CPR for at least 2 min. Conclusion: This study provides positive evidence for routine use of AEDs with AWC-integrated algorithm for ECG analysis during CPR by first-responders in early OHCA treatment.Clinical Trial Registration: Registration number: NCT04691089, trial register: ClinicalTrials.gov.

An 18-year-old drowning victim was successfully resuscitated using prehospital veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Despite 24 min of submersion in water with a surface temperature of 15 °C, the patient was cannulated on-scene and transported to a trauma center. After ICU admission on VA-ECMO, he was decannulated and extubated by day 5. He was transferred to a peripheral hospital on day 6 and discharged home after 3.5 weeks with favorable neurological outcome of a Cerebral Performance Categories (CPC) score of 1 out of 5. This case underscores the potential of prehospital ECMO in drowning cases within a well-equipped emergency response system.

Objective: The aim of this study was to analyze the feasibility of a new resuscitation strategy in which breaths are provided during automated external defibrillator (AED) rhythm analysis, and to evaluate its impact on chest compressions (CC) quality and the peri-analysis time. Method: A randomized simulation study, comparing two cardiopulmonary resuscitations strategies, has been conducted: the standard strategy (S1) with strategy involving ventilation during AED analysis (S2). Thirty lifeguards have performed both strategies in a cross-over study design during 10 min of CPR. Results: The number of ventilations per 10 min increases from 47 (S1) to 72 (S2) (p

Background: This study aimed to construct and internally validate a probability of the return of spontaneous circulation (ROSC) rate nomogram in a Chinese population of patients with cardiac arrest (CA). Methods: Patients with CA receiving standard cardiopulmonary resuscitation (CPR) were studied retrospectively. The minor absolute shrinkage and selection operator (LASSO) regression analysis and multivariable logistic regression evaluated various demographic and clinicopathological characteristics. A predictive nomogram was constructed and evaluated for accuracy and reliability using C-index, the area under the receiver operating characteristic curve (AUC), calibration plot, and decision curve analysis (DCA). Results: A cohort of 508 patients who had experienced CA and received standard CPR was randomly divided into training (70 %, n = 356) and validation groups (30 %, n = 152) for the study. LASSO regression analysis and multivariable logistic regression revealed that thirteen variables, such as age, CPR start time, Electric defibrillation, Epinephrine, Sodium bicarbonate (NaHCO3), CPR Compression duration, The postoperative prothrombin (PT) time, Lactate (Lac), Cardiac troponin (cTn), Potassium (K+), D-dimer, Hypertension (HBP), and Diabetes mellitus (DM), were found to be independent predictors of the ROSC rate of CPR. The nomogram model showed exceptional discrimination, with a C-index of 0.933 (95 % confidence interval: 0.882–0.984). Even in the internal validation, a remarkable C-index value of 0.926 (95 % confidence interval: 0.875–0.977) was still obtained. The accuracy and reliability of the model were also verified by the AUC of 0.923 in the training group and 0.926 in the validation group. The calibration curve showed the model agreed with the actual results. DCA suggested that the predictive nomogram had clinical utility. Conclusions: A predictive nomogram model was successfully established and proved to identify the influencing factors of the ROSC rate in patients with CA. During cardiopulmonary resuscitation, adjusting the emergency treatment based on the influence factors on ROSC rate is suggested to improve the treatment rate of patients with CA.

Background: We aimed to identify the factors affecting the inhospital Cardiopulmonary Resuscitation (CPR) to investigate the effect of the time of in-hospital CPR on its immediate outcome in pediatric patients. Methods: This retrospective study investigated CPR events performed at a teaching hospital in Tehran, Iran, from March 2018 to March 2019. After obtaining the necessary academic and ethical approvals, the pertinent data were transcribed from patient records and analyzed. No identifying data about patients or their families were extracted. Results: Chi-square test showed a significant difference in the occurrence of CPR on two-hour time blocks (p=0.041), with dips at 0-2 a.m. and 12-2 p.m. and heights at 2-4 p.m. and 6-8 p.m. (representing 5, 6, 17 and 17 CPR events, respectively). The occurrence of CPR during the night shift was significantly less than in the morning and evening shifts (p=0.000 and 0.005 respectively). Of 161 subjects with a known immediate outcome of CPR, 86 (53.4%) survived, and 75 (46.6%) died. The outcome was significantly less favorable in the evening shift compared to the morning shift (p=0.028), but no significant differences in the outcome were found between morning and night shifts (p=0.163), evening and night shifts (p=0.256), day and night (p=0.637) or workdays and weekends (p=0.925). Conclusion: We found a significantly higher occurrence of CPR at 2-4 p.m. and 6-8 p.m., at the beginning and end of the evening shift and a higher rate of post-CPR death in this shift. [ABSTRACT FROM AUTHOR]

Objective To investigate the popularization of cardiopulmonary resuscitation (CPR) knowledge and science popularization needs among urban and rural residents in Tonghai County, Yuxi City, Yunnan Province, so as to explore the establishment of an efficient and appropriate science popularization model. Methods A total of 300 residents aged 15-60 years old were selected from Tonghai County, Yuxi City, Yunnan Province using stratified and simple random sampling methods. A self-designed questionnaire was used to conduct an anonymous questionnaire survey. Results Only 20.3% of Tonghai County residents master CPR skills, and 26.2% of Tonghai County residents have never heard of CPR. There is a statistically significant difference in the awareness rate of CPR between rural residents and non-rural residents (P<0.01). There are differences in residents' age and CPR awareness (P<0.01), the age and CPR are inversely proportional. The residents have a higher willingness to perform chest compressions and mouth-to-mouth resuscitation on strangers, 66.2% and 68.6% respectively. 63.79% of residents have never attended relevant training. But 92.76% of the people said they were willing to participate in the relevant training when they learned the training news. Conclusion Residents in Tonghai County generally lack knowledge of CPR first aid, but the demand for first aid knowledge of residential CPR is high and the attitude towards rescue is positive. It is recommended that relevant departments increase CPR science popularization and training efforts, and popularize CPR into villages. [ABSTRACT FROM AUTHOR]

Background: App-linked real-time feedback-devices for cardiopulmonary resuscitation (CPR) aim to improve laypersons’ resuscitation quality. Resuscitation guidelines recommend these technologies in training settings. This is the first study comparing resuscitation quality of all App-linked feedback-devices currently on market. Methods: A prospective randomised simulation study was performed. After standardised instructions, participants performed 2-minutes compression-only CPR on a manikin without feedback (baseline). Afterwards, participants performed 4 × 2 min CPR with four different feedback devices in randomised order (CorPatch® Trainer, CPRBAND AIO Training, SimCPR®ProTrainer, Relay Response™) (intervention). CPR metrics (chest compression depth (CD), chest compression rate (CR), percentage of correct CD/CR (%), correct hand position, correct chest recoil, and technical preparation-time) were assessed. Devices data were compared to the baseline group using Wilcoxon testing with IBM SPSS (primary outcome). Differences between devices were analysed with ANOVA testing (secondary outcome). Normally distributed data were described as mean ± standard deviation (SD) and non-normally distributed data as Median [Interquartile range (IQR). CPR self-confidence was measured by means of questionnaire before and after feedback devices’ use. Comparison was performed by students t-test. Results: Forty participants were involved. SimCPR®ProTrainer was the only device, which resulted in guideline-compliant chest compressions (Mean ± SD:5.37 ± 0.76) with improved chest compression depth (p

Aim: Current guidelines for cardiopulmonary resuscitation (CPR) recommend a one-size-fits-all approach in relation to the positioning of chest compressions. We recently developed RescueDoppler, a hands-free Doppler ultrasound device for continuous monitoring of carotid blood flow velocity during CPR. The aim of the present study is to investigate whether RescueDoppler via real-time hemodynamic feedback, could identify both optimal and suboptimal compression positions. Methods: In this model of animal cardiac arrest, we induced ventricular fibrillation in five domestic pigs. Manual chest compressions were performed for ten seconds at three different positions on the sternum in random order and repeated six times. We analysed Time Average Velocity (TAV) with chest compression position as a fixed effect and animal, position, and sequential time within animals as random effects. Furthermore, we compared TAV to invasive blood pressure from the contralateral carotid artery. Results: We were able to detect changes in TAV when altering positions. The positions with the highest (range 19 to 48 cm/s) and lowest (6–25 cm/s) TAV were identified in all animals, with corresponding peak pressure 50–81 mmHg, and 46–64 mmHg, respectively. Blood flow velocity was, on average, highest at the middle position (TAV 33 cm/s), but with significant variability between animals (SD 2.8) and positions within the same animal (SD 9.3). Conclusion: RescueDoppler detected TAV changes during CPR with alternating chest compression positions, identifying the position yielding maximal TAV. Future clinical studies should investigate if RescueDoppler can be used as a real-time hemodynamical feedback device to guide compression position.

Objective: This study introduces a novel system that can simulate diverse mechanical properties of the human chest to enhance the experience of CPR training by reflecting realistic chest conditions of patients. Methods: The proposed system consists of Variable stiffness mechanisms (VSMs) and Variable damper (VD) utilizing stretching silicone bands and dashpot dampers with controllable valves to modulate stiffness and damping, respectively. Cyclic loading was applied with a robot manipulator to the system. Compression force and displacement were measured and analyzed to evaluate the system’s mechanical response. Long-term stability of the system was also validated. Results: A non-linear response of the human chest under compression is realized through this design. Test results indicated non-linear force-displacement curves with hysteresis, similar to those observed in the chest of patients. Controlling the VSM and VD allowed for intentional changes in the slope and area of curves that are related to stiffness and damping, respectively. Stiffness and damping of the system were computed using performance test results. The stiffness ranged from 5.34 N/mm to 13.59 N/mm and the damping ranges from 0.127 N $\cdot $ s/mm to 0.511 N $\cdot $ s/mm. These properties cover a significant portion of the reported mechanical properties of the human chests. The system demonstrated satisfactory stability even when it was subjected to maximum stiffness conditions of the long-term compression test. Conclusion: The system is capable of emulating the mechanical properties and behavior of the human chests, thereby enhancing the CPR training experience.

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This study investigates the implementation, effectiveness, and impact of a unique e-learning system designed specifically for emergency signs and cardiopulmonary resuscitation (CPR) emergency preparedness in marathon events. Our approach introduces the first e-learning system specifically designed for marathon events. It delivers engaging content, including infographic stories, expert lectures, and interactive modules, to provide registered runners with comprehensive knowledge of first aid and emergency signs for CPR. To evaluate the e-learning application, we conducted a comparative experiment during the CMU (Chiang Mai University) marathon with 9,761 participants. We used pre- and post-tests, as well as a survey questionnaire. The results showed significant improvements in participants' CPR knowledge across all educational backgrounds. The integration of e-learning into the registration process contributed to a safer marathon environment, as participants felt more confident in handling emergencies. Approximately 85% of participants expressed a willingness to recommend the e-learning system. This increased confidence among participants in handling emergencies benefits both runners and marathon organizers by enhancing safety measures and emergency response during events. In conclusion, our findings strongly support the integration of e-learning into the registration process for marathon events. Recommendations based on our research include providing comprehensive guidelines for other marathon events, instilling stakeholder confidence, and emphasizing the suitability of e-learning for medium- to largescale events. However, caution is advised for smaller events due to potential complexities and costs. Additionally, we suggest limiting the validity of e-certificates to ensure that participants have up-to-date CPR knowledge. [ABSTRACT FROM AUTHOR]

This article discusses a study conducted in Lahore, Pakistan, which aimed to understand the public perception and willingness towards bystander cardiopulmonary resuscitation (CPR) training and performance. The study found that only 2.3% of individuals in Pakistan receive bystander CPR during out-of-hospital cardiac arrest. Lack of awareness about the importance of bystander CPR and fear of causing harm were the main reasons for not participating in CPR training. The study highlights the need to improve CPR training and public education in Pakistan. The study also examines the barriers and driving forces behind bystander CPR in Pakistan, such as fear of disease transmission and legal actions. The authors recommend that the government and organizations create a strategic plan to improve bystander CPR performance through education, legislation, and creating an encouraging atmosphere. However, the study has limitations in terms of sample size and hypothetical analysis. [Extracted from the article]

Background: There is growing interest in the quality of manual ventilation during cardiopulmonary resuscitation (CPR), but accurate assessment of ventilation parameters remains a challenge. Waveform capnography is currently the reference for monitoring ventilation rate in intubated patients, but fails to provide information on tidal volumes and inspiration–expiration timing. Moreover, the capnogram is often distorted when chest compressions (CCs) are performed during ventilation compromising its reliability during CPR. Our main purpose was to characterize manual ventilation during CPR and to assess how CCs may impact on ventilation quality. Methods: Retrospective analysis were performed of CPR recordings fromtwo databases of adult patients in cardiac arrest including capnogram, compression depth, and airway flow, pressure and volume signals. Using automated signal processing techniques followed by manual revision, individual ventilations were identified and ventilation parameters were measured. Oscillations on the capnogram plateau during CCs were characterized, and its correlation with compression depth and airway volume was assessed. Finally, we identified events of reversed airflow caused by CCs and their effect on volume and capnogram waveform. Results: Ventilation rates were higher than the recommended 10 breaths/min in 66.7% of the cases. Variability in ventilation rates correlated with the variability in tidal volumes and other ventilatory parameters. Oscillations caused by CCs on capnograms were of high amplitude (median above 74%) and were associated with low pseudo-volumes (median 26 mL). Correlation between the amplitude of those oscillations with either the CCs depth or the generated passive volumes was low, with correlation coefficients of −0.24 and 0.40, respectively. During inspiration and expiration, reversed airflow events caused opposed movement of gases in 80% of ventilations. Conclusions: Our study confirmed lack of adherence between measured ventilation rates and the guideline recommendations, and a substantial dispersion in manual ventilation parameters during CPR. Oscillations on the capnogram plateau caused by CCs did not correlate with compression depth or associated small tidal volumes. CCs caused reversed flow during inspiration, expiration and in the interval between ventilations, sufficient to generate volume changes and causing oscillations on capnogram. Further research is warranted to assess the impact of these findings on ventilation quality during CPR. [ABSTRACT FROM AUTHOR]

High-quality cardiopulmonary resuscitation (CPR) is the most important factor in promoting resuscitation outcomes; therefore, monitoring the quality of CPR is strongly recommended in current CPR guidelines. Recently, transesophageal echocardiography (TEE) has been proposed as a potential real-time feedback modality because physicians can obtain clear echocardiographic images without interfering with CPR. The quality of CPR would be optimized if the myocardial ejection fraction (EF) could be calculated in real-time during CPR. We conducted a study to derive a protocol to detect systole and diastole automatically and calculate EF using TEE images acquired from patients with cardiac arrest. The data were supplemented using thin-plate spline transformation to solve the problem of insufficient data. The deep learning model was constructed based on ResUNet + + , and a monogenic filtering method was applied to clarify the ventricular boundary. The performance of the model to which the monogenic filter was added and the existing model was compared. The left ventricle was segmented in the ME LAX view, and the left and right ventricles were segmented in the ME four-chamber view. In most of the results, the performance of the model to which the monogenic filter was added was high, and the difference was very small in some cases; but the performance of the existing model was high. Through this learned model, the effect of CPR can be quantitatively analyzed by segmenting the ventricle and quantitatively analyzing the degree of contraction of the ventricle during systole and diastole. [ABSTRACT FROM AUTHOR]

Aim: Propose new metrics of impulsiveness of manual chest compressions (CCs) that account for shape and duration, separate the characteristics of the compressive part of the CC cycle from those of the recoil part, and are uncorrelated to CC depth and rate. Methods: We conducted a retrospective analysis of adult out-of-hospital cardiac arrest monitor-defibrillator recordings having CPR data. Specifically, episodes of adult patients with ≥ 1000 compressions free of leaning were examined. CCs were obtained from the depth signal of the valid episodes, and we calculated the novel metrics: compression area index (CAI), recoil area index (RAI), compression impulsiveness index (CII) and recoil impulsiveness index (RII). Generalized linear mixed-effects models and Jonckheere-Terpstra trend analyses were employed to measure differences between populations and trends, and the absolute value of Pearson's correlation coefficient |r| was used to report dependence between variables. Statistics are reported as median and interquartile range. Results: We analyzed 982,340 CCs corresponding to 453 episodes, for which we calculated their CAI, RAI and duty cycle (DC). We analyzed the metrics for various populations: age, sex, any ROSC achieved and disposition, and found that CAI was significantly different according to patient disposition and RAI relative to age and sex (p

Background: During pulseless electrical activity (PEA) the cardiac mechanical and electrical functions are dissociated, a phenomenon occurring in 25–42% of in-hospital cardiac arrest (IHCA) cases. Accurate evaluation of the likelihood of a PEA patient transitioning to return of spontaneous circulation (ROSC) may be vital for the successful resuscitation. The aim: We sought to develop a model to automatically discriminate between PEA rhythms with favorable and unfavorable evolution to ROSC. Methods: A dataset of 190 patients, 120 with ROSC, were acquired with defibrillators from different vendors in three hospitals. The ECG and the transthoracic impedance (TTI) signal were processed to compute 16 waveform features. Logistic regression models where designed integrating both automated features and characteristics annotated in the QRS to identify PEAs with better prognosis leading to ROSC. Cross validation techniques were applied, both patient-specific and stratified, to evaluate the performance of the algorithm. Results: The best model consisted in a three feature algorithm that exhibited median (interquartile range) Area Under the Curve/Balanced accuracy/Sensitivity/Specificity of 80.3(9.9)/75.6(8.0)/ 77.4(15.2)/72.3(16.4) %, respectively. Conclusions: Information hidden in the waveforms of the ECG and TTI signals, along with QRS complex features, can predict the progression of PEA. Automated methods as the one proposed in this study, could contribute to assist in the targeted treatment of PEA in IHCA.

Aim: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is time-dependent. To date, evidence-based training programmes for dispatchers are lacking. This study aimed to reach expert consensus on an educational bundle content for dispatchers to provide DA-CPR using the Delphi method. Method: An educational bundle was created by the Swedish Resuscitation Council consisting of three parts: e-learning on DA-CPR, basic life support training and audit of emergency out-of-hospital cardiac arrest calls. Thereafter, a two-round modified Delphi study was conducted between November 2022 and March 2023; 37 experts with broad clinical and/or scientific knowledge of DA-CPR were invited. In the first round, the experts participated in the e-learning module and answered a questionnaire with 13 closed and open questions, whereafter the e-learning part of the bundle was revised. In the second round, the revised e-learning part was evaluated using Likert scores (20 items). The predefined consensus level was set at 80%. Results: Delphi rounds one and two were assessed by 20 and 18 of the invited experts, respectively. In round one, 18 experts (18 of 20, 90%) stated that they did not miss any content in the programme. In round two, the scale-level content validity index based on the average method (S-CVI/AVE, 0.99) and scale-level content validity index based on universal agreement (S-CVI/UA, 0.85) exceeded the threshold level of 80%. Conclusion: Expert consensus on the educational bundle content was reached using the Delphi method. Further work is required to evaluate its effect in real-world out-of-hospital cardiac arrest calls.

Introduction: Extracorporeal membrane oxygenation (ECMO) improves infant survival outcomes after cardiac arrest. If not feasible at the place of arrest, victims must be transported to a suitable room to perform ECMO while effective, sustained resuscitation maneuvers are performed. The objective of this simulation study was to compare the quality of resuscitation maneuvers on an infant manikin during simulated transfer on a stretcher (stretcher test) within a hospital versus standard stationary resuscitation maneuvers (control test). Methods: A total of 26 nursing students participated in a randomized crossover study. In pairs, the rescuers performed two 2 min tests, consisting of five rescue breaths followed by cycles of 15 compressions and two breaths. The analysis focused on CPR variables (chest compression and ventilation), CPR quality, the rate of perceived exertion and the distance covered. Results: No differences were observed in the chest compression quality variable (82 ± 10% versus 84 ± 11%, p = 0.15). However, significantly worse values were observed in the test for ventilation quality on the stretcher (18 ± 14%) compared to the control test (28 ± 21%), with a value of p = 0.030. Therefore, the overall CPR quality was worse in the stretcher test (50 ± 9%) than in the control test (56 ± 13%) (p = 0.025). Conclusions: Infant CPR performed by nursing students while walking alongside a moving stretcher is possible. However, in this model, the global CPR quality is less due to the low ventilation quality.

Objective: To compare Femoral and Internal jugular veins for rapid fluid and drug administration during ongoing cardiopulmonary resuscitation. Study Design: Prospective longitudinal study. Place and Duration of Study: Intensive Care Unit, Frontier Corps Hospital, Quetta Pakistan, from Aug 2019 to Jan 2020. Methodology: After Ethical Committee Approval, 60 consecutive critical patients of ICU were inlcuded and divided into Femoral and Internal Jugular Groups as per the catheterization they received during cardiopulmonary resuscitation. The landmark technique was used in both groups. Success rate along with complications were compared between groups. Results: In the Femoral (F) Group, cannulation was successful in 28 patients (93.3%) out of 30 patients, whereas in the Internal Jugular (I) Group, out of 30 patients, 22(73.3%) patients were successfully cannulated. Inadvertent carotid and femoral artery punctures occurred in 6 patients (20.0%) in the Internal Jugular-Group and one patient (3.3%) in the Femoral-Group, respectively. In contrast, soft tissue injury occurred due to more than one attempt in 5 patients (16.7%) in the Internal JugularGroup and two patients (6.7%) in the Femoral-Group. Conclusion: The study concluded that femoral vein cannulation is superior to internal jugular cannulation for successful resuscitation in critical care patients without disruption of chest compression and, therefore, should be the method of choice in these patients.

Introduction: Cardiac arrest in the operating room is a rare but potentially life-threatening event with mortality rates of more than 50%. Contributing factors are often known, and the event is recognised rapidly as patients are usually under full monitoring. This guideline covers the perioperative period and is complementary to the European Resuscitation Council guidelines. Material And Methods: The European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery jointly nominated a panel of experts to develop guidelines for the recognition, treatment, and prevention of cardiac arrest in the perioperative period. A literature search was conducted in MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. All searches were restricted to publications from 1980 to 2019 inclusive and to the English, French, Italian and Spanish languages. The authors also contributed individual, independent literature searches. Results: This guideline contains background information and recommendation for the treatment of cardiac arrest in the operating room environment, and addresses controversial topics such as open chest cardiac massage, resuscitative endovascular balloon occlusion and resuscitative thoracotomy, pericardiocentesis, needle decompression, and thoracostomy. Conclusions: Successful prevention and management of cardiac arrest during anaesthesia and surgery requires anticipation, early recognition, and a clear treatment plan. The ready availability of expert staff and equipment must also be taken into consideration. Success not only depends on medical knowledge, technical skills and a well-organised team using crew resource management, but also on an institutional safety culture embedded in everyday practice through continuous education, training, and multidisciplinary co-operation. [ABSTRACT FROM AUTHOR]

Aim. With the advent of an aging society and the development of end-of-life care, there is an increasing need to understand the older generation's attitude toward end-of-life resuscitation. The study aimed to develop and validate a novel attitude scale toward end-of-life resuscitation in older inpatients. Method. Instrumental development and a psychometric evaluation were used. First, a new attitude scale toward end-of-life resuscitation was formulated from literature views, expert content validity, and face validity. Next, the new scale was evaluated using a principal component analysis and internal consistency reliability in a sample from 106 medical–surgical inpatients in a southern Taiwan hospital 1 enrolled through convenience sampling. Serving as an indicator of concurrent validity, a logistic regression analysis was performed to analyze the association between scores on the scale and intention to discuss end-of-life CPR issues. Results: After being validated by the expert content validity and face validity, a draft of a 20-item scale was created. Throughout the exploratory factor analysis, two items with low factor loadings were removed from the draft scale and an 18-item scale of attitude was generated. This 18-item scale had a three-factor structure that accounted for 64.1% of the total variance; the three components were named 'stress, avoidance, and ignorance', 'a peaceful death', and 'self-determination and ambivalence'. The Cronbach's alpha of the total scale and three components were 0.845, 0.885, 0.879, and 0.857, respectively, which indicated a favorable reliability. Scores on the scale were significantly associated with the intention to discuss end-of-life CPR issues, which also indicated a favorable concurrent validity. Conclusions: A 18-item attitude scale with three factors is a valid scale to measure the attitude toward end-of-life resuscitation. The result provides preliminary evidence of the psychometric properties of the scale. Further research with larger samples or other populations is required. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the quality of standard infant CPR with CPR in motion (i.e., walking and running) via performing maneuvers and evacuating the infant from a beach. Thirteen trained lifeguards participated in a randomized crossover study. Each rescuer individually performed three tests of 2 min each. Five rescue breaths and cycles of 30 chest compressions followed by two breaths were performed. Mouth-to-mouth-and-nose ventilation was carried out, and chest compressions were performed using the two-fingers technique. The manikin was carried on the rescuer's forearm with the head in the distal position. The analysis variables included compression, ventilation, and CPR quality variables, as well as physiological and effort parameters. Significantly lower compression quality values were obtained in running CPR versus standard CPR (53% ± 14% versus 63% ± 15%; p = 0.045). No significant differences were observed in ventilation or CPR quality. In conclusion, lifeguards in good physical condition can perform simulated infant CPR of a similar quality to that of CPR carried out on a victim who is lying down in a fixed position. [ABSTRACT FROM AUTHOR]

The effect of the dimensions of the thoracic cage on the resuscitation outcome of cardiopulmonary resuscitation (CPR) maneuvers has long been debated. In this study, the effect of changes in the rib cage dimensions on the achieved compression depth was investigated using finite element simulations. A total of 216 different rib cage geometry models were considered and, in each case, the result of applying different levels of compression force up to 600 N were simulated. The Haller Index of the rib cage is defined as the ratio of the transverse diameter and the antero‐posterior diameter. Our results suggest that, with a fixed level of compression force, performing CPR on rib cages having a low Haller Index and/or a larger height leads to compression depths below the average. Alternatively, if a target compression depth is set for CPR, in general a lower compression force would be required for individuals with higher Haller Index and/or lower chest height. In addition, present results indicate that wider chested individuals will experience lower stress levels on their ribs to achieve the required CPR target depth. Moreover, in the present study we propose predictive models, based on anthropometric parameters, for compression depth and rib stress during chest compressions. In particular, the model suggests that in future correlations of empirical CPR data the patients' Haller index and vertical (sagittal) cross‐area are the best parameters to be used as independent variables in a fit. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) is a major rescue measure for cardiac arrest (CA) patients, and chest compression is the key to CPR. The Thumper device was designed to facilitate manual compression during CPR. However, current randomized controlled trials (RCTs) provide controversial findings on the efficacy of the Thumper device. Objectives: This meta-analysis aimed to compare the clinical benefits of using the Thumper device with manual chest compressions during the provision of CPR for patients in CA. Methods: Relevant studies were retrieved from various databases, including Ovid, PubMed, Web of Science, EMBASE, Cochrane, and CNKI, and by manually searching the reference lists of research and review articles. All RCTs published in either English or Chinese until June 31, 2020, were included in the meta-analysis. The odds ratios (ORs) and their 95% confidence intervals (95% CIs) for the return of spontaneous circulation (ROSC), survival rate (SR), and the incidence of rib fractures (RFs) were compared between the manual and Thumper chest compressions. Results: A total of 2164 records were identified, of which 16 were RCTs with an overall risk of bias ranging from low to medium classification. Following CPR, the odds ratios for ROSC, SR, and RF were significantly better for the Thumper chest compression with ORs of 2.56 (95% CI 2.11-3.11, I2 = 0%), 4.06 (95% CI 2.77-5.93, I2 = 0%), and 0.24 (95% CI 0.14-0.41, I2 = 0%), respectively. Conclusions: The Thumper compression devices may improve patient outcome, when used at inhospital cardiac arrest. This review suggests a potential role for mechanical chest compression devices for in-hospital cardiac arrest, but there is an urgent need for high-quality research, particularly adequately powered randomised trials, to further examine this role. [ABSTRACT FROM AUTHOR]

Background/Aim: Bystander cardiopulmonary resuscitation (CPR) during out of-hospital cardiac arrest increases both survival rates and neurological recovery, but in Pakistan, an alarmingly low 2.3 % of these individuals receive bystander CPR. This study was designed to identify the reasons that affect the perception and willingness of the public toward bystander CPR training and performance in Lahore, Pakistan. Methods: A CPR master trainer from the USA visited various organisations from 1 December 2022 to 31 January 2023, to conduct training sessions. Before and after the training, a questionnaire was distributed among respondents to fill in. The subjects were asked to answer questions about their perception and willingness to perform bystander CPR. Results: Out of 401 participants, 240 completed the survey, with a response rate of 59.85 %. The majority of them were males [146 (60.8 %)], 215 (89.6 %) were below the age of 40, 107 (44.6 %) were graduated, 182 (75.8 %) never participated in any CPR training, mainly due to their ignorance towards the importance of bystander CPR (52.8 %) and 152 (63.3 %) were eager to participate in the CPR training course. Furthermore, the leading problem in providing bystander CPR was lack of technique or fear of possible harm that can be proved fatal (48.8 %), followed by concerns related to involvement in any legal procedure (10.0 %). Conclusions: Bystander CPR is still uncommon in Pakistan. Participants were reluctant to perform bystander CPR because of various concerns and fears. Lack of proper skill and causing additional harm were the main reasons associated with this. Hence, while improving CPR training and public education, these findings must be considered.

Background: In Germany, 70,000–100,000 persons per year suffer from out-of-hospital cardiac arrest (OHCA). Despite medical progress, survival rates with good neurological outcome remain low. For many important clinical issues, no or only insufficient evidence from randomised trials is available. Therefore, a systemic and standardised acquisition of the treatment course and of the outcome of OHCA patients is warranted. Study design: The German Cardiac Arrest Registry (G-CAR) is an observational, prospective, multicentre registry. It will determine the characteristics, initial treatment strategies, invasive procedures, revascularisation therapies and the use of mechanical circulatory support devices with a focus on extracorporeal cardiopulmonary resuscitation. A special feature is the prospective 12-month follow-up evaluating mortality, neurological outcomes and several patient-reported outcomes in the psychosocial domain (health-related quality of life, cognitive impairment, depression/anxiety, post-traumatic stress disorder and social reintegration). In a pilot phase of 24 months, 15 centres will include approximately 400 consecutive OHCA patients ≥ 18 years. Parallel to and after the pilot phase, scaling up of G-CAR to a national level is envisaged. Conclusion: G-CAR is the first national registry including a long-term follow-up for adult OHCA patients. Primary aim is a better understanding of the determinants of acute and long-term outcomes with the perspective of an optimised treatment. Trial registry: NCT05142124. German Cardiac Arrest Registry (G-CAR) [ABSTRACT FROM AUTHOR]

IntroductionEarly and effective cardiopulmonary resuscitation (CPR) increases both survival rate and post–cardiac arrest quality of life. This study aims to assess the current knowledge and ability of physicians and nurses in health centers (HCs) operated by the Primary Health Care Corporation (PHCC) in Doha, Qatar, to perform CPR.MethodologyThis study consists of two parts. The first part is a descriptive cross-sectional survey using an online form targeting physicians and nurses working in all HCs to assess their CPR knowledge and attitude. The second part is a direct observation of CPR drills to evaluate the skills and competencies of code blue team members in a convenient sample of 14 HCs. A multivariate model was employed to test the independent effect of explanatory variables on the total knowledge score.ResultsA total of 569 physicians and nurses responded to the survey. Only one-half (48.7%) formally received training on basic life support within the last year. Furthermore, 62.7% have tried to revive a dying person with no pulse. All the participants recognize the importance of knowing how to revive a dying adult or child as part of their job. The study showed that being a nurse was the most important predictor of a higher knowledge score in both components. Attending more resuscitation courses (3–6 courses in the last 3 years) ranked second in importance, and a longer experience in clinical practice (5–10 and >10 years) ranked third in predictive power. In addition, the direct observation of CPR drill performance revealed a satisfactory outcome.ConclusionThe level of CPR knowledge and skills practice among healthcare providers in PHCC is deemed satisfactory as most providers reported having performed CPR in the past. Considering that PHCC is the first step to people’s healthcare in Qatar, clinical staff should be certified and assessed regularly to ensure retention of resuscitation knowledge and skills.

IntroductionLittle work has been done on out-of-hospital cardiac arrest (OHCA) in Saudi Arabia. Our goal is to report the characteristics of OHCA patients and predictors of bystander cardiopulmonary resuscitation (CPR).Materials and methodsThis cross-sectional study utilized data from the Saudi Red Crescent Authority (SRCA), a governmental emergency medical service (EMS). A standardized data collection form based on the “Utstein-style” guidelines was developed. Data were retrieved from the electronic patient care reports that SRCA providers fill out for every case. OHCA cases that were attended by SRCA in Riyadh province between June 1st, 2020 and May 31st, 2021 were included. Multivariate regression analysis was performed to assess independent predictors of bystander CPR.ResultsA total of 1,023 OHCA cases were included. The mean age was 57.2 (±22.6). 95.7% (979/1,023) of cases were adults and 65.2% (667/1,023) were males. Home was the most common location of OHCA [784/1,011 (77.5%)]. The initial recorded rhythm was shockable in 131/742 (17.7%). The EMS mean response time was 15.9 min (±11.1). Bystander CPR was performed in 130/1,023 (12.7%) and was more commonly performed in children as compared to adults [12/44 (27.3%) vs. 118/979 (12.1%), p = 0.003]. Independent predictors of bystander CPR were being a child (OR = 3.26, 95% CI [1.21–8.82], p = 0.02) and having OHCA in a healthcare institution (OR = 6.35, 95% CI [2.15–18.72], p = 0.001).ConclusionOur study reported the characteristics of OHCA cases in Saudi Arabia using EMS data. We observed young age at presentation, low rates of bystander CPR, and long response time. These characteristics are distinctly different from other countries and call for urgent attention to OHCA care in Saudi Arabia. Lastly, being a child and having OHCA in a healthcare institution were found to be independent predictors of bystander CPR.

The success of cardiopulmonary resuscitation (CPR) in newborns largely depends on effective lung ventilation; however, a direct randomized comparison using different available devices has not yet been performed. Thirty-six professionals were exposed to a realistic newborn CPR scenario. Ventilation with either a bag-valve mask (BVM), T-piece, or ventilator was applied in a randomized manner during CPR using a Laerdal manikin. The primary outcome was the number of unimpaired inflations, defined as the peak of the inflation occurring after chest compression and lasting at least 0.35 s before the following chest compression takes place. The secondary outcomes were tidal volume delivered and heart compression rate. To simulate potential distractions, the entire scenario was performed with or without a quiz. Statistically, a mixed model assessing fixed effects for experience, profession, device, and distraction was used to analyze the data. For direct comparison, one-way ANOVA with Bonferroni's correction was applied. The number of unimpaired inflations was highest in health care professionals using the BVM with a mean ± standard deviation of 12.8 ± 2.8 (target: 15 within 30 s). However, the tidal volumes were too large in this group with a tidal volume of 42.5 ± 10.9 ml (target: 25–30 ml). The number of unimpaired breaths with the mechanical ventilator and the T-piece system were 11.6 (±3.6) and 10.1 (±3.7), respectively. Distraction did not change these outcomes, except for the significantly lower tidal volumes with the T-piece during the quiz. In summary, for our health care professionals, ventilation using the mechanical ventilator seemed to provide the best approach during CPR, especially in a population of preterm infants prone to volutrauma. [ABSTRACT FROM AUTHOR]

Aluminium phosphide (ALP) and aluminium zinc phosphide (ZnP), the two main ingredients of fumigation drugs, are commonly used to kill insects or rodents in grain. When exposed to water, highly toxic phosphine gas is released and absorbed through the respiratory or digestive tract. Phosphine gas could non-selectively block cytochrome oxidase, inhibit electron transfer and suppress oxidative phosphorylation, leading to cellular hypoxia and organ dysfunction. The characteristic clinical manifestations are refractory shock and metabolic acidosis with high mortality. However, patients with ALP poisoning have a chance to be cured. Here, we report a case of oral ALP poisoning that was successfully treated by extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT) during frequent ventricular fibrillation and cardiac dysfunction. [ABSTRACT FROM AUTHOR]

Objective: Out-of-hospital cardiac arrest (OHCA) is a prominent cause of death worldwide. As indicated by the high proportion of COVID-19 suspicion or diagnosis among patients who had OHCA, this issue could have resulted in multiple fatalities from coronavirus disease 2019 (COVID-19) occurring at home and being counted as OHCA. Methods: We used the MeSH term "heart arrest" as well as non-MeSH terms "out-of-hospital cardiac arrest, sudden cardiac death, OHCA, cardiac arrest, coronavirus pandemic, COVID-19, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)." We conducted a literature search using these search keywords in the Science Direct and PubMed databases and Google Scholar until 25 April 2022. Results: A systematic review of observational studies revealed OHCA and mortality rates increased considerably during the COVID-19 pandemic compared to the same period of the previous year. A temporary two-fold rise in OHCA incidence was detected along with a drop in survival. During the pandemic, the community's response to OHCA changed, with fewer bystander cardiopulmonary resuscitations (CPRs), longer emergency medical service (EMS) response times, and worse OHCA survival rates. Conclusions: This study's limitations include a lack of a centralised data-gathering method and OHCA registry system. If the chain of survival is maintained and effective emergency ambulance services with a qualified emergency medical team are given, the outcome for OHCA survivors can be improved even more. [ABSTRACT FROM AUTHOR]

End-stage renal disease (ESRD) patients on long-term hemodialysis (HD) have an elevated risk of sudden cardiac death. This study hypothesizes, for the first time, that these patients have a higher odds of return of spontaneous circulation (ROSC) and subsequent better hospital-outcomes, post out-of-hospital cardiac arrest (OHCA), as opposed to non-ESRD patients. A national database from Taiwan was utilized, in which 101,876 ESRD patients undergoing HD and propensity score-matched non-ESRD patients were used to conduct two analyses: (i) Cox-proportional-hazards-regression for OHCA incidence and (ii) logistic-regression analysis of attaining ROSC after OHCA, both for ESRD patients in comparison to non-ESRD patients. Kaplan-Meier analyses were conducted to determine the difference of survival rates after ROSC between the two cohorts. ESRD patients were found to be at a higher risk of OHCA (adjusted-HR = 2.11, 95% CI: (1.89–2.36), p < 0.001); however, they were at higher odds of attaining ROSC (adjusted-OR = 2.47, 95% CI: 1.90–3.21, p < 0.001), as opposed to non-ESRDs. Further, Kaplan-Meier analysis demonstrated ESRD patients with a better 30-day hospital survival rate than non-ESRD patients. Although ESRD patients had a higher risk of OHCA, they demonstrated higher possibility of ROSC and a better short-term hospital outcome than non-ESRDs. Chronic toxin tolerance and the training of vascular-compliance during regular HD may be possible explanations for better outcomes in ESRD patients. [ABSTRACT FROM AUTHOR]

Background: There are few studies that analyze ventilation volume and pressure during CPR carried out on infants. The aim of this study was to evaluate the quality of the ventilations administered using a self-inflating bag with an endotracheal tube and a face mask in manikins. Methods: a quasi-experimental simulation study with a randomized case crossover design [endotracheal tube (ET) vs. face mask (FM)] was performed. Sixty participants who were previously trained nursing students participated in the study. The estimated air volumes breathed, and the pressure generated during each ventilation were assessed and the quality of the chest compressions was recorded. Results: the ET test presented a higher percentage of ventilations that reached the lungs (100% vs. 86%; p < 0.001), with adequate volume (60% vs. 28%; p < 0.001) in comparison to FM. Both tests presented peak pressures generated in the airway greater than 30 cm H2O (ET: 22% vs. FM: 31%; p = 0.03). Conclusions: performing quality CPR ventilations on an infant model is not an easy skill for trained nursing students. Both tests presented a significant incidence of excessive peak pressure during ventilations. Specific training, focused on quality of ventilations guided by a manometer attached to the self-inflating bag, must be considered in life support training for pediatric providers. [ABSTRACT FROM AUTHOR]

Aim. With the advent of an aging society and the development of end-of-life care, there is an increasing need to understand the older generation’s attitude toward end-of-life resuscitation. The study aimed to develop and validate a novel attitude scale toward end-of-life resuscitation in older inpatients. Method. Instrumental development and a psychometric evaluation were used. First, a new attitude scale toward end-of-life resuscitation was formulated from literature views, expert content validity, and face validity. Next, the new scale was evaluated using a principal component analysis and internal consistency reliability in a sample from 106 medical–surgical inpatients in a southern Taiwan hospital 1 enrolled through convenience sampling. Serving as an indicator of concurrent validity, a logistic regression analysis was performed to analyze the association between scores on the scale and intention to discuss end-of-life CPR issues. Results: After being validated by the expert content validity and face validity, a draft of a 20-item scale was created. Throughout the exploratory factor analysis, two items with low factor loadings were removed from the draft scale and an 18-item scale of attitude was generated. This 18-item scale had a three-factor structure that accounted for 64.1% of the total variance; the three components were named ‘stress, avoidance, and ignorance’, ‘a peaceful death’, and ‘self-determination and ambivalence’. The Cronbach’s alpha of the total scale and three components were 0.845, 0.885, 0.879, and 0.857, respectively, which indicated a favorable reliability. Scores on the scale were significantly associated with the intention to discuss end-of-life CPR issues, which also indicated a favorable concurrent validity. Conclusions: A 18-item attitude scale with three factors is a valid scale to measure the attitude toward end-of-life resuscitation. The result provides preliminary evidence of the psychometric properties of the scale. Further research with larger samples or other populations is required.

The aim of this study was to compare the quality of standard infant CPR with CPR in motion (i.e., walking and running) via performing maneuvers and evacuating the infant from a beach. Thirteen trained lifeguards participated in a randomized crossover study. Each rescuer individually performed three tests of 2 min each. Five rescue breaths and cycles of 30 chest compressions followed by two breaths were performed. Mouth-to-mouth-and-nose ventilation was carried out, and chest compressions were performed using the two-fingers technique. The manikin was carried on the rescuer’s forearm with the head in the distal position. The analysis variables included compression, ventilation, and CPR quality variables, as well as physiological and effort parameters. Significantly lower compression quality values were obtained in running CPR versus standard CPR (53% ± 14% versus 63% ± 15%; p = 0.045). No significant differences were observed in ventilation or CPR quality. In conclusion, lifeguards in good physical condition can perform simulated infant CPR of a similar quality to that of CPR carried out on a victim who is lying down in a fixed position.